Apparatus and method for locating defects in bone tissue

Abstract

An instrument for locating defects adjacent neural elements in bone tissue includes a handle member with a rotatable coupling member and a probe member coupled to the coupling member. The probe member extends distally from the handle member and includes a longitudinal shaft portion along a longitudinal axis and a distal angled portion extending transversely to the longitudinal axis. The angled portion has a probe end that carries an electrical signal. The handle member operates to rotate the probe member and the probe end about the longitudinal axis to sweep holes in the bone tissue to locate possible defects in the bone tissue.

1 . An instrument for locating defects within bone tissue, comprising: 
 a handle member including a rotatable coupling member; and    a probe member coupled to said coupling member of said handle member and extending distally therefrom, wherein said probe member includes a longitudinal shaft portion along a longitudinal axis and a distal angled portion extending transversely to said longitudinal axis, wherein said angled portion includes a probe end at a distal end thereof for carrying an electrical signal, wherein said handle member is operable to rotate said coupling member and said probe member and said probe end about said longitudinal axis to locate defects in bone tissue.    
     
     
         2 . The instrument of  claim 1 , wherein said probe end is a ball tip.  
     
     
         3 . The instrument of  claim 1 , wherein said handle member extends along said longitudinal axis.  
     
     
         4 . The instrument of  claim 1 , wherein a patient reaction to said electrical signal determines a proximity of neural elements to said probe end.  
     
     
         5 . The instrument of  claim 4 , wherein the proximity of neural elements provides an indication of a defect location.  
     
     
         6 . The instrument of  claim 1 , further comprising an electrical lead extending from said probe member through said handle member.  
     
     
         7 . The instrument of  claim 1 , wherein said longitudinal shaft portion and said distal angled portion are composed of an electrically conductive material and are insulated.  
     
     
         8 . The instrument of  claim 7 , wherein said probe end is non-insulated.  
     
     
         9 . The instrument of  claim 1 , wherein at least said distal angled portion of said probe member is structured for positioning in a hole formed in a spinal pedicle wall to receive an anchor.  
     
     
         10 . The instrument of  claim 1 , wherein said handle member includes a motor operable to rotate said coupling member and said probe member about said longitudinal axis.  
     
     
         11 . The instrument of  claim 1 , wherein said handle member includes a circuit and a motor operable to rotate said probe member about the longitudinal axis within a first hole in the bone tissue.  
     
     
         12 . The instrument of  claim 11 , wherein said handle member is operable to automatically stop rotation of said probe member at the defect location in the bone tissue.  
     
     
         13 . The instrument of  claim 1 , wherein in operation: 
 said probe end stops rotation in alignment with a defect in the bone tissue; and    an operator display device displays a representation of the location of the defect relative to the longitudinal axis.    
     
     
         14 . The instrument of  claim 1 , further comprising a connection link extending from a proximal end of said handle member to a nerve monitoring system.  
     
     
         15 . The method of  claim 14 , wherein said nerve monitoring system includes an operator display device.  
     
     
         16 . The instrument of  claim 15 , wherein said probe member is operable for rotation about said longitudinal axis when said probe end is positioned in a first hole in the bone tissue.  
     
     
         17 . The instrument of  claim 16 , wherein said operator display device displays a representation of positioning of said probe end relative to said longitudinal axis as said probe member is rotated.  
     
     
         18 . The instrument of  claim 17 , wherein said operator display device displays a representation of a location of a defect relative to said longitudinal axis.  
     
     
         19 . The instrument of  claim 18 , wherein the instrument is operable to automatically stop rotation of said probe member upon detection of the defect.  
     
     
         20 . A method, comprising: 
 providing a defect locating instrument, wherein said defect locating instrument includes a probe member operably and rotatably coupled to a handle member, wherein said probe member includes a distal angled portion extending transversely to a longitudinal axis of said probe member, wherein said angled portion includes a distal non-insulated probe end rotatable about the longitudinal axis of said probe member as said probe member is rotated;    inserting said probe end of said defect locating instrument in a first hole in bone tissue;    providing an electrical signal to said probe end; and    rotating said probe end about the longitudinal axis to locate neural elements in the bone tissue about the first hole.    
     
     
         21 . The method of  claim 20 , wherein the first hole in the bone tissue is a bore formed in a spinal pedicle wall to receive an anchor.  
     
     
         22 . The method of  claim 20 , further comprising providing an operator display device operably connected to said defect locating instrument to display a representation of the rotation of said probe end about the longitudinal axis.  
     
     
         23 . The method of  claim 22 , wherein when no neural elements are located by said probe end, said probe member is removed from the first hole and an anchor is inserted into the first hole.  
     
     
         24 . The method of  claim 22 , wherein when a signal indicates the proximity of a neural element a defect is located by said probe end and said operator display device displays a representation of a location of the defect relative to the longitudinal axis.  
     
     
         25 . The method of  claim 24 , wherein said probe end stops rotation about the longitudinal axis adjacent the defect.  
     
     
         26 . The method of  claim 25 , further comprising: 
 redirecting said defect locating instrument in a direction away from the defect; and    rotating said probe end about the longitudinal axis to locate neural elements in the direction away from the defect.    
     
     
         27 . The method of  claim 25 , further comprising: 
 removing said probe member from the first hole;    forming a second hole in the bone tissue; and    inserting said probe end in the second hole, wherein said probe end rotates about the longitudinal axis to locate neural elements in the second hole.    
     
     
         28 . A neural element detection apparatus, comprising: 
 a locating instrument including a handle member and a probe member, wherein said probe member includes a shaft portion extending along a longitudinal axis and a distal angled portion, wherein said distal angled portion includes a probe end at a distal end thereof operable to carry an electrical signal and rotate about the longitudinal axis to detect neural elements in bone tissue about a first hole in a pedicle wall when inserted in the hole; and    an operator display device to display a representation of the rotation of said probe end relative to the longitudinal axis and a location of a defect indicated by detection of neural elements in the bone tissue about said probe end.    
     
     
         29 . The apparatus of  claim 28 , wherein: 
 upon detection of the neural element a signal is provided to said locating instrument to stop rotation of said probe end adjacent the defect; and    said operator display device displays a location of the probe end and thus the defect relative to the longitudinal axis.    
     
     
         30 . The apparatus of  claim 28 , wherein: 
 said shaft portion and said angled portion are insulated and are composed of an electrically conductive material; and    said probe end is non-insulated.    
     
     
         31 . The apparatus of  claim 28 , further comprising a nerve monitoring system electrically coupled to said locating instrument.  
     
     
         32 . A system, comprising: 
 a handle member, wherein said handle member includes a circuit and a motor operable to rotate a coupling member of said handle member;    a probe member including a proximal end and a distal end opposite said proximal end, wherein said proximal end of said probe member is coupled to said coupling member of said handle member, wherein said probe member includes a longitudinal shaft portion extending along a longitudinal axis at said proximal end and a distal angled portion extending transversely to said longitudinal axis adjacent said distal end, wherein said distal angled portion includes a probe end at said distal end rotatable about said longitudinal axis and operable to carry an electrical signal to detect neural elements in bone tissue; and    a nerve monitoring system electrically coupled to said probe member operable to indicate a proximity of neural elements to said probe end.    
     
     
         33 . The system of  claim 32 , wherein said nerve monitoring system includes an operator display device operable to display a location of said probe end relative to said longitudinal axis.  
     
     
         34 . The system of  claim 33 , wherein upon detection of a neural element a defect in the bone tissue is located and a signal is provided to said circuit to stop said motor and rotation of said probe member with said probe end adjacent the defect.  
     
     
         35 . The system of clam  34 , wherein said operator display device is operable to display a location of the defect relative to said longitudinal axis.  
     
     
         36 . A method, comprising: 
 providing a defect locating instrument, wherein said defect locating instrument includes a probe member operably and rotatably coupled to a handle member, wherein said probe member includes a distal non-insulated probe end rotatable about a longitudinal axis of said probe member;    inserting said probe end of said defect locating instrument in a first hole in bone tissue;    providing an electrical signal to said probe end;    rotating said probe end about the longitudinal axis;    adjusting said electrical signal as said probed end is rotated until detecting a neural element or reaching a signal threshold.    
     
     
         37 . The method of  claim 36 , wherein said distal angled portion extends transversely to a longitudinal axis of said probe member.  
     
     
         38 . A system, comprising: 
 a handle member;    a probe member including a proximal end and a distal end opposite said proximal end, wherein said proximal end of said probe member is coupled to said handle member, wherein said probe member includes a longitudinal shaft portion extending along a longitudinal axis to a distal probe end, said probe end including a plurality of stimulation elements positioned thereabout to alternately deliver electrical stimulation to adjacent tissue; and    a nerve monitoring system electrically coupled to said probe member operable to indicate a proximity of a neural element to any of said plurality of stimulation elements.    
     
     
         39 . The system of  claim 38 , wherein said probe end is a ball end and said plurality of stimulation elements are in said ball end.  
     
     
         40 . The system of  claim 38 , wherein said longitudinal shaft portion of said probe member is linear.